Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35170 | MO |
NPI | 1043359029 |
---|---|
Provider Name | Dr. Piemsak Lim |
First Address | Perryville, MO 63775-1382 |
Second Address | Perryville, MO 63775-1382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 04/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A10152 | (02) |